Nonarterialized venous replantation of part of amputated thumb-a case report and review of the literature
Research article published in Hand (New York, N.Y.) (2006)
Abstract
Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including "pocket procedures" to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful "arterialization" of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted composite body part (bone, tendon, soft tissues, and skin) utilizing exclusively multiple, microvascular, nonarterialized venous-venous anastomoses. We present a patient with an isolated band saw fillet amputation to the back of the thumb at the metacarpal-phalangeal joint region, resulting in a composite graft composed of bone, tendon, soft tissue, and skin. The hand wound provided no viable regional arterial inflow source, but there were multiple good caliber superficial veins present. The amputated tissues were replanted and revascularized by using only venous blood flow. The replanted part survival was 100% with excellent function of the digit. We conclude that a hand composite body part involving bone, tendon, soft tissues, and skin can survive replantation with a strict venous blood supply if sufficient good caliber, microvascular, venous-venous anastomoses are performed, granted that arterial inflow options are not available. This is an isolated case, yet introduces a new way of thinking regarding tissue replantation.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe un paciente con amputación aislada del pulgar por sierra de banda que fue sometido a reimplante exitoso utilizando exclusivamente anastomosis microvasculares venovenosas no arterializadas, alcanzando una supervivencia tisular del 100 % con excelente función del dedo. El resumen menciona las sanguijuelas medicinales como una de varias técnicas reconocidas en la literatura para maximizar la supervivencia tisular tras la revascularización. Esto es relevante para el ámbito de ASH en la medida en que la terapia con sanguijuelas es reconocida como un complemento establecido en el salvamento de tejidos reimplantados e injertos compuestos. Sin embargo, las sanguijuelas solo se mencionan de pasada como uno de los múltiples métodos disponibles; este caso en realidad no empleó terapia con sanguijuelas. La evidencia se refiere a una novedosa técnica quirúrgica exclusivamente venosa y representa un único caso aislado.
Citación
Nonarterialized venous replantation of part of amputated thumb-a case report and review of the literature
Kalimuthu R et al. · Hand (New York, N.Y.), 2006
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026